In this case-based discussion, Drs. Dolinger and Rubin examine the diagnostic approach to patients presenting with signs and symptoms suggestive of inflammatory bowel disease (IBD). The conversation explores key steps in the initial evaluation, appropriate laboratory testing, the role of colonoscopy versus additional noninvasive work-up, and how imaging modalities such as intestinal ultrasound contribute to disease characterization. The faculty also address methods to assess disease severity and activity, incorporating clinical indices, endoscopic findings, and risk stratification.